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Fieldwork Request Form


Name:
Home Phone:
Daytime Phone:
Cell Phone:
Email Address:
Street Address:
City:
State:
Zip Code:
Total Hours Needed:
Grade level requested:
Do you need to complete fieldwork/service learning in a particular content area or activity (e.g. Language Arts, Math, PE, Music, etc)? Please describe.
If requesting service learning for SPED 200 (Disability Studies), what skills or special interests do you have that may be an asset in your service learning assignment? (describe)
Class for which you are doing your observation/fieldwork:
Please describe the class assignment for which you are completing this fieldwork or service learning:
Instructor's Name
Number of visits requested, and number of hours per visit:
Specific days and times available (note: observation requests may take up to a week to complete. Please note school hours listed above):
What type of work do you need to do with the students?
With how many children do you need to work?
Other considerations:

Create a web form here
Upcoming Events
11/1 Charter School - Pupil Free Day
11/11 Veterans Day
11/25 Charter School - Thanksgiving Break 11/25 - 11/29



 
 
Imagine a world where all children are equally valued, a world where all children are seen as a gift.
CHIME Early Childhood
Infant/Toddler Program
Tel: 818-677-2922
CHIME Preschool
Inclusion Program
Tel: 818-677-2922
CHIME Institute's Schwarzenegger
Community School
Tel: 818-346-5100